A Tailored De-Implementation Strategy to Reduce Low-Value Home-Based Nursing Care: A Mixed-Methods Feasibility Study.
Benjamin Wendt, Minke S Nieuwboer, Hester Vermeulen and 2 others
PMID 39540659WHAT IT FOUND
Washing frequency did not change after seven Dutch home-care teams replaced daily soap-and-water washing with washing without water, but time spent per client per week on low-value care fell 17.94% over six months.
Key findings
01Mean time spent on low-value care per client per week was 74.17 minutes at follow-up and 90.38 minutes at baseline, with a reported 17.94% difference.
02Mean frequency of low-value care per client per week was 3.57 at follow-up and 3.75 at baseline, and the change was not statistically significant.
03Self-reported guideline-based advice improved from 2.45 to 2.92 on a 1 to 4 scale and was statistically significant.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
There was no control group or randomisation, so the before and after change cannot be attributed to the strategy alone. Teams were selected for availability and motivation, and some may have already been reducing low-value care, creating a flooring effect. The time measure relied on nurses' best educated guess and manual care-plan data, which may bias results. The sample was small and skewed, and teams 5, 6 and 7 had small client samples. The knowledge and skills questionnaire was short, self-reported, not validated, and felt like added workload. The cost-benefit analysis covered only teams 1 to 5 and assumed saved time can be fully used. Follow-up was six months, and the study did not test long-term maintenance. Clients and relatives were not included as study participants, so their experience of reduced washing was not measured.
Declared interests
The authors declared no conflicts of interest. The study was funded by ZonMw.
The easy way to misread this
Do not read the 17.94% time reduction as proof that the strategy caused less low-value care. The frequency outcome was not significant, and the study had no control group or randomisation.